P-1829. Low Hepatocellular Carcinoma Surveillance Among Cirrhotic Patients in a Mobile and Telehealth HCV Elimination Program

TL;DR

A mobile and telehealth HCV elimination program in New Jersey found low rates of HCC screening among cirrhotic patients after treatment.

Contribution

The study highlights challenges in HCC surveillance engagement in a mobile and telehealth HCV treatment model.

Findings

Only 43% of reachable cirrhotic patients reported primary care follow-up for HCC screening.

None of the 46 reachable patients had received a six-month surveillance liver ultrasound.

56% of cirrhotic patients were lost to follow-up after HCV treatment.

Abstract

We evaluated the proportion of patients diagnosed with cirrhosis through our hepatitis C (HCV) elimination program in New Jersey who engaged in biannual hepatocellular carcinoma (HCC) screening. The program operates through a mobile van that collects initial bloodwork at drug addiction treatment facilities across New Jersey, followed by a telehealth consultation with an infectious disease physician for liver fibrosis staging and treatment recommendations.

We conducted a cross-sectional observational study of patients diagnosed with liver cirrhosis who achieved sustained virologic response (SVR) through our HCV elimination program. Following SVR, intensive follow-up was provided by a registered nurse, case manager, 340B coordinator, and pharmacist. At the SVR visit, patients with cirrhosis were counseled to establish six-month HCC surveillance with a primary care provider or specialist. Patients diagnosed with cirrhosis on or before September 30, 2024, were contacted in April 2025 to assess their engagement in an HCC screening program.

Between June 1, 2021, and September 30, 2024, 1,897 patients with HCV were evaluated; 120 (6.3%) were diagnosed with cirrhosis. The median age was 55 years (34–72), and 91 (76%) were male. Among the 120 patients contacted, 67 (56%) were lost to follow-up, 3 (2.5%) had died, 3 (2.5%) were incarcerated, and 1 (0.8%) was hospitalized. Of the 46 reachable patients, 16 (35%) reported no follow-up, 20 (43%) reported PCP follow-up, and 8 (17%) reported subspecialist follow-up. None had received a six-month surveillance liver ultrasound.

Despite targeted education, referrals, and case management, engagement in HCC surveillance among cirrhotic patients treated through a mobile and telehealth model remained low. Future efforts should prioritize developing intervention strategies to strengthen linkage to HCC surveillance after HCV cure.

Jihad Slim, MD, FACP, gilead: Honoraria|merck: Honoraria|Thera: Honoraria|ViiV: Honoraria Kevin Leyden, RN, RN, Abbvie Inc.: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support